National Medical Examiner update - February 2021 Welcome
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National Medical Examiner update February 2021 Welcome I am delighted the government published the White Paper earlier this month, including measures to put medical examiners on a statutory footing. The Royal College of Pathologists also shared their success with the 1000th medical examiner trained. You can read more about these important milestones below. In my October 2020 bulletin, I mentioned my plan to publish a series of brief good practice papers for medical examiners, to support medical examiners and medical examiner officers in working more effectively with colleagues and partners. The Royal College of Pathologists recently published the first of these, which considers how medical examiners can support people of Black, Asian and minority ethnic heritage and their relatives. I am very grateful to the college, and to Dr Habib Naqvi MBE, the Director of NHS Race and Health Observatory, who with other colleagues helped to shape this document. I plan to publish papers exploring other relevant issues in coming weeks and months. We now have medical examiner offices in almost all acute trusts in England, and in all areas of Wales the medical examiner service continues to make excellent progress. I am delighted to welcome Rajiv Prinja to the national medical examiner team in the role of finance analyst for England. I am encouraged that despite pressures, the overwhelming majority of medical examiner offices in England have successfully submitted Q3 data. Together with information from the medical examiner service in Wales, this will provide more comprehensive information about medical examiner activity in both nations. Dr Alan Fletcher, National Medical Examiner
What’s included in this update
• Statutory medical examiner system
• Working with the Chief Coroner
• Good Practice Series – BAME paper
• Excess deaths and potential delays
• England – Quarter 3 submissions update
• Implementation in Wales
• Digital update
• Medical examiner recruitment
• Training and events
• Contact details
.
Statutory medical examiner system
The Health and Care White Paper has been published which highlights plans to bring
forward measures that contribute to improved quality and safety in the NHS, including the
introduction of a statutory medical examiner system. This is a significant step to putting the
medical examiner system on a statutory footing. It is anticipated that the non-statutory
medical examiner system will continue throughout the 2021/22 financial year whilst
parliamentary procedure is followed.
Working with the Chief Coroner
In December it was announced that the new Chief Coroner is His Honour Judge Thomas
Teague QC.
The seventh annual report of the Chief Coroner, covering 2018/2019 and 2019/20 has also
been published. The report again expresses support for the medical examiner system, and
notes the close work between the National Medical Examiner and the Chief Coroner of
England and Wales.
In recent times, progress included publication of the Notification of Deaths Regulations 2019
and associated guidance, which provide a consistent national framework for notifications to
coroners.
I wish to thank the previous Chief Coroner, His Honour Judge Mark Lucraft QC, Recorder of
London, for his support to the medical examiner system and look forward to working with his
successor.
2 | National medical examiner update – February 2021Good practice series – BAME paper
The Royal College of Pathologists has just published the first of a new series of National
Medical Examiner good practice papers. The first of these papers explores how medical
examiners can better meet the needs of people from Black, Asian and minority ethnic
communities. It provides recommendations, a summary of the context and background, and
links for further reading. This was developed with stakeholders including the Ministry of
Justice; Chief Coroners Office; Department of Health and Social Care; Welsh Government;
General Register Office; and the Office for National Statistics; along with input from subject
matter experts. We plan to add to the series with papers on other topical issues in the
coming months.
Excess deaths and potential delays
Heartfelt thanks are extended to medical examiners and medical examiner officers for their
ongoing dedication and commitment despite the unprecedented pressures that trusts and
health boards have faced during the pandemic.
Recent weeks have seen the NHS facing huge pressures, and sadly the increase in COVID-
19 infections over the Christmas and New Year period has resulted in more deaths than
usual. There have been significant implications for medical examiner officers and we are
grateful for the hard work and dedication shown across England and Wales. Where the
pressures continue, it is worth ensuring that all medical practitioners continue to utilise the
Coronavirus Act easements for excess deaths, and continue to work closely with colleagues
in related areas such as mortuaries and bereavement services, and registrars. Close
working can help reassure members of the public and communities who may have concerns
about the impact of the pandemic on death certification processes.
England – Quarter 3 submissions update
We are delighted the overwhelming majority of medical examiner offices (119) completed
their Q3 2020/21 submission. This will help us to process reimbursement payments and also
provides very positive information about the continued progress medical examiners are
making. We understand the considerable pressures faced by medical examiners and other
staff in trusts, and are grateful for these completed submissions. Medical examiner offices
that require further support completing their submission should liaise with their regional
medical examiner officer.
Q4 data for 2020/21 is due to be submitted via the online portal between 1 April 2021 and
11pm on Monday 19 April 2021. Information on how to access the portal has been sent
previously. Please contact reporting.nme@nhs.net if you have any queries.
3 | National medical examiner update – February 2021Separate arrangements are in place for reporting and funding of the medical examiner
service in Wales.
Implementation in Wales
The medical examiner service for Wales is now scrutinising deaths that occur in the majority
of acute hospitals, as well as a number of community hospitals and hospices (both NHS and
private) and deaths that occur in the community. The team is increasingly able to apply its
specialist knowledge and skills across all four regions in Wales.
The impact the service is having is underlined by very positive feedback from the bereaved,
coroners offices, registrars and health boards. We are building on this to refine systems and
processes to improve services, for example, health boards have committed to provide
clinical notes digitally. With remote access to clinical records across Wales, and a fully
functioning case management system, medical examiners in any of the four regional offices
can scrutinise deaths that occur anywhere in Wales.
Increased COVID-19 infections in Wales are adding to pressures, and although no
suspension of service has been required, staff were released to support the front line by
completing MCCDs and cremation forms. It is likely that building up and expanding the
service will take longer in coming months, particularly as general practices are supporting
the vaccination programme.
Digital update
NHS Business Services Authority (NHSBSA) continues to make positive progress on the
development of a digital system for the medical examiner system. NHSBSA and the
Department of Health and Social Care really appreciate medical examiner offices which are
supporting user research. Rollout of the medical examiner digital system is anticipated
through the financial year 2021/22 and communications to support this will be issued to
enable medical examiner officers to plan local implementation. NHSBSA are also
undertaking the digitisation of the Medical Certificate of Cause of Death, which is in its early
stages of development.
Medical examiner recruitment
During 2021, there will be a need to recruit more medical examiners, particularly to increase
capacity to extend scrutiny to deaths outside acute settings. Previous bulletins and the
National Medical Examiners’ Good Practice Guidelines note the importance of appointing
medical examiners with a range of specialties and skills. For trusts in England and NWSSP
in Wales, this means it is important to advertise widely and ensure that senior doctors in non-
4 | National medical examiner update – February 2021acute providers including GP practices are made aware of employment opportunities and are
able to apply. Lead medical examiners are also encouraged to carefully consider the
recommendations set out in the good practice series paper regarding medical examiners and
Black, Asian and minority ethnic communities. A diverse workforce will widen the skills and
perspectives of medical examiner offices and will help medical examiners build links across
the healthcare system and with communities.
Training and events
The Royal College of Pathologists are to be congratulated for reaching a tremendous
milestone this month, having trained the 1000th medical examiner on 9 February 2021. This
is a fantastic achievement made possible by the dedication and support of the Royal College
of Pathologists, the faculty team, and participants.
The continued appetite for medical examiner and medical examiner officer training is
extremely encouraging. Additional training dates have been scheduled. Details can be found
on the Royal College of Pathologists' website. The medical examiner officer training record
and supporting documents are now available.
A reminder that places can also be booked for the medical examiners' annual conference on
27 April 2020 featuring keynote speakers including Nadine Dorries MP, Minister for Patient
Safety, Sir Robert Francis QC (Chair, Healthwatch England), and Keith Conradi (Chief
Investigator, HSIB).
Contact details
We encourage you to continue to raise queries with us and share your thoughts on the
introduction of medical examiners, through the contacts list. The page contains contact
details for the national medical examiner’s office, the medical examiner team in Wales, and
regional medical examiner contacts in England.
Further information
Further information about the programme, including previous editions of this bulletin, can
be found on the national medical examiner webpage.
NHS Wales Shared Services Partnership also has a web page for the medical examiner
system in Wales.
© NHS England and NHS Improvement February 2021
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